Provider Demographics
NPI:1558718486
Name:PAW, THANAY
Entity Type:Individual
Prefix:
First Name:THANAY
Middle Name:
Last Name:PAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 SUPERIOR AVE E STE 214
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-4128
Mailing Address - Country:US
Mailing Address - Phone:216-361-1223
Mailing Address - Fax:216-361-1568
Practice Address - Street 1:3820 SUPERIOR AVE E STE 214
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-4128
Practice Address - Country:US
Practice Address - Phone:216-361-1223
Practice Address - Fax:216-361-1568
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-1798850171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109544Medicaid